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587 Springfield Ave | Summit, NJ 07901 | (O) 908-598-8088 | (F) 908-368-8628 | www.hwis.org New Jersey After School Enrichment Registration Form HudsonWay Immersion School Student Non-HudsonWay Immersion School Student Student Information Name: _________________________________ Gender: ________ Date of birth: ______/______/______ Current grade: ______________ Current school name & address: __________________________________ _____________________________________________________________________________________________ Parent Information Name of Parent/Guardian #1:_____________________________ Relationship to child:_________________ Email: _______________________________________________ Cell Phone:_________________________ Name of Parent/Guardian #2:_____________________________ Relationship to child:_________________ Email: _______________________________________________ Cell Phone:_________________________ Please check your selected class(es) and session(s) Day & Time Classes Per Session Fee Session I (Oct - Dec) Session II (Jan-Apr) Session III (Apr-June) Saturday 10:00 AM- 12:00 PM Abacus Class (Abacus Math and Mental Math for K and Elementary levels) $575 + $50 for materials including a textbook and an Abacus (12 classes) TOTAL Program Information Classes are taught in English Class offerings are subject to change per trimester. Registrationn is first come, first served. A completed registration form and full payment are required to reserve your child’s spot. Please make checks payable to HudsonWay Immersion School and send with your registration form. Non-HudsonWay Immersion School students, please continue to complete the next page.

Abacus Enrichment Registration Form - HudsonWay ...hwis.org/.../2014/08/Abacus-Enrichment-Registration-Form.pdfAbacus Class (Abacus Math and Mental Math for K and Elementary levels)

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587 Springfield Ave | Summit, NJ 07901 | (O) 908-598-8088 | (F) 908-368-8628 | www.hwis.org

New Jersey After School Enrichment Registration Form

HudsonWay Immersion School Student Non-HudsonWay Immersion School Student Student Information Name: _________________________________ Gender: ________ Date of birth: ______/______/______

Current grade: ______________ Current school name & address: __________________________________

_____________________________________________________________________________________________

Parent Information

Name of Parent/Guardian #1:_____________________________ Relationship to child:_________________

Email: _______________________________________________ Cell Phone:_________________________

Name of Parent/Guardian #2:_____________________________ Relationship to child:_________________

Email: _______________________________________________ Cell Phone:_________________________

Please check your selected class(es) and session(s)

Day & Time Classes Per Session Fee Session I (Oct-Dec)

Session II (Jan-Apr)

Session III (Apr-June)

Saturday 10:00 AM- 12:00 PM

Abacus Class (Abacus Math and Mental Math for K and Elementary levels)

$575 + $50 for materials including a

textbook and an Abacus (12 classes)

TOTAL Program Information

• Classes are taught in English • Class offerings are subject to change per trimester. • Registrationn is first come, first served. • A completed registration form and full payment are required to reserve your child’s spot. • Please make checks payable to HudsonWay Immersion School and send with your registration form.

Non-HudsonWay Immersion School students, please continue to complete the next page.

587 Springfield Ave | Summit, NJ 07901 | (O) 908-598-8088 | (F) 908-368-8628 | www.hwis.org

   

 

Allergies (Required, Non-HudsonWay Immersion School Students) If your child has any allergies or health concerns that we should be made aware of, please list them here: ________________________________________________________________________________________________

Medical Authorization (required for non-HudsonWay Immersion School students)

In case of emergency, please provide an emergency contact who can be called and is authorized to pick up you child if we cannot reach a parent. Emergency contact name: __________________________________ Phone: _______________________________

Relationship to child: ______________________________________________________________________________

Photo/Video Permission (required, non-HudsonWay Immersion School students)

When classes are in session, there are times when pictures or videos may be taken to showcase an activitiy or an event.

Photos or videos may be used internally or in school marketing materials, including our school’s website.

Yes, I give my permission to use pictures or videos of my child taken at classes, including on the internet and in printed

materials.

No, I do not give my permission to use pictures or videos of my child taken at classes. Pick-up/Drop-off Authorization (other than parent) (Required, Non-HudsonWay Immersion School Students)

Name: _______________________________________ Phone: ____________________________ Relationship to child: _____________________________________

This authorization applies as follow: _____Pick up _____Drop off

This authorized person will perform this function: _____Sometimes _____Always This authorization will remain in effect until canceled by me.

____________________________ (Signature) __________________ (today’s date)

Parent Signature ______________________________ Date: _____________________________